The Cost of Odontogenic Infections: a Demographic, Financial, and Outcome Variable Analysis
Odontogenic infections are one of the most commonly managed pathologies by oral and maxillofacial surgeons. Not only do they elicit severe pain, discomfort, and loss of productivity from the patients, but the infections can be a burden on clinic schedules and emergency room space. While one study has described the cost impact of these infections, no prior studies have analyzed these costs. In this study, we aim to describe the trends associated with the insurance coverage, identify the variables associated with cost of care, and analyze these factors leading to increased or decreased cost in patients admitted for odontogenic infections.
Patients and Methods
A retrospective chart review was conducted on patients admitted for odontogenic infections at Harborview Medical Center between July 1st, 2001 and June 30th, 2011. The outcome variable used to assess the financial impact of the variables was the total dollar amount billed to the patient.
Methods of Data Analysis
Multiple linear or logistic regression models were created for the outcome variables of interest, total amount billed, length of stay (LOS), intensive care unit (ICU) use, and additional operating room (OR) use.
Results
A total of 318 patients were reviewed and included. The unsponsored portion of our patient population grew from 14.7% to 61.9% over the course of the study. The average hospital bill per patient in this study was $17,053, which amounted to $5,422,838 over the study period. Of this, only $1,528,869 was received by the hospital in payment for the services rendered and $3,893,969 in potential revenue was lost. The variables location of treatment, LOS, ICU use, length of ICU stay, and additional OR use accounted for 85.4% of the variation in hospital bill. In the multivariate linear regression analysis on LOS, the variables drug abuse, location of treatment, number of spaces involved, side/location of infection, ICU use, length of ICU stay, additional OR use, admission white blood cell count, peak white blood cell count, and peak blood sugar accounted for 68.2% of the variation. In the multivariate logistic regression analysis on ICU use, the variables operating time, number of spaces involved, and peak blood sugar accounted for 32.5% of the variation. Length of stay was the only variable significantly associated with additional OR use in the multivariate analysis.
Conclusion
For unsponsored patients to make up 61.9% of the patient population represents an enormous challenge for hospitals and providers. To maintain the standard of care for all patients and still be able to provide care to patients without insurance, county hospitals and academic institutions must seek to improve cost efficiency. Our findings reinforce the need to be vigilant about the decisions to admit, take to the OR, admit to ICU, and discharge to reduce the costs to the patient, hospital, and society from the management of odontogenic infections. Our understanding of the key variables involved in the LOS in patients with odontogenic infections has been greatly improved by recent studies and reinforced by the present study. We present a starting point for greater understanding of the variables involved in ICU use but much more work is needed to address variables identifying patients needing reoperation. Future studies should be aimed creating multivariate models that explain all of variation in these key outcome variables.
References
1. Flynn TR, Shanti RM, Hayes C: Severe odontogenic infections, part 2: prospective outcomes study. J Oral Maxillofac Surg 64:1104, 2006
2. Jundt JS, Gutta R: Characteristics and cost impact of severe odontogenic infections. Oral Surg Oral Med Oral Pathol Oral Radiol 114:558, 2012